Simultaneous physiological sensing and stimulation with saturation detection

ABSTRACT

Systems and method may be used for interfacing with a patient. Systems may include a plurality of electrodes in electrical communication with a processor. The processor may be configured to receive sense signals from electrodes and to determine the reliability of the received signal. A test tone signal comprising a test tone frequency may be applied, and the magnitude of the test tone frequency may be analyzed in the received signal. If it is determined that the magnitude of the test tone frequency is below a threshold, the system may take action, such as lowering the gain on an amplifier. Stimulation signals may be applied to the patient at a stimulation frequency simultaneously with one or both of receiving sense signals and providing the test tone signal.

BACKGROUND

Patients afflicted with movement disorders or other neurodegenerativeimpairment, whether by disease or trauma, may experience muscle controland movement problems, such as rigidity, bradykinesia (i.e., slowphysical movement), rhythmic hyperkinesia (e.g., tremor), nonrhythmichyperkinesia (e.g., tics) or akinesia (i.e., a loss of physicalmovement). Movement disorders may be found in patients with Parkinson'sdisease, multiple sclerosis, and cerebral palsy, among other conditions.Delivery of electrical stimulation and/or a fluid (e.g., apharmaceutical drug) by a medical device to one or more sites in apatient, such as a brain, spinal cord, leg muscle or arm muscle, in apatient may help alleviate, and in some cases, eliminate symptomsassociated with movement or other nervous disorders.

During a programming session, which may occur during implant of themedical device, during a trial session, or during a follow-up sessionafter the medical device is implanted in the patient, a clinician maygenerate one or more therapy programs that provide efficacious therapyto the patient, where each therapy program may define values for a setof therapy parameters. A medical device may deliver therapy to a patientaccording to one or more stored therapy programs. In the case ofelectrical stimulation, the therapy parameters may definecharacteristics of the electrical stimulation waveform to be delivered.Where electrical stimulation is delivered in the form of electricalpulses, for example, the parameters may include an electrodecombination, an amplitude, which may be a current or voltage amplitude,a pulse width, a pulse shape, and a pulse rate.

The sensing and monitoring of electrical signals from the patient'snervous system can be an important aspect of therapeutic and diagnosticprocedures. However, such sensing and monitoring presents challenges.Neurological bioelectrical signals have relatively small magnitudescompared to those in other areas of the body, such as cardiac signals,for example. Accordingly, these signals are typically amplified foranalysis. However, the application of electrical stimulation obscuresthese neurological bioelectrical signals during the application of thestimulation. For example, saturation of the amplifiers results, therebyrendering the sensed signal unreliable. As a result, bioelectricalsignals are not typically measured during stimulation. Instead, sensingelectrodes are often blocked during stimulation and re-enabled afterstimulation in an attempt to observe the effect of the stimulationpulse. However, such blocking and re-enabling practice can result inmissing useful information that occurs during the stimulation itself.

SUMMARY

Aspects of the present disclosure are generally directed to systems andmethods for interfacing with a patient. Methods can include receiving asense signal from a patient. The sense signal may be processed toproduce a process signal. Methods may include monitoring at least onereliability signal indicative of the reliability of the sense signal orprocessed signal. In some examples, in the event that the reliabilitysignal meets at least one predetermined criterion, the method includesperforming at least one action to improve the reliability of the sensesignal or processed signal.

In some examples, methods can include applying a test tone signal withfrequency content comprising a test frequency. Methods can includemonitoring the magnitude of the test frequency in the sense signal orprocessed signal and comparing the magnitude of the processed signal toa threshold. In some such examples, the reliability signal may includethe magnitude of the test frequency in the processed signal or sensesignal.

Some methods can include applying a stimulation signal comprising astimulation frequency. The stimulation signal may be appliedsimultaneously with receiving a sense signal, and in some examples, bothmay be performed simultaneously with applying a test tone signal. Insome examples, the stimulation frequency, the test frequency, and thefrequency content of signals of interest in the sense signal aredistinct. For example, in some methods, the stimulation frequency may bewithin a first frequency band, signal of interest may include frequencycontent within a second band separate from the first, and the testfrequency may be outside of both of the first and second frequencybands.

Systems according to embodiments of the disclosure may include aprocessor and a plurality of electrodes for interfacing with a patient.In some examples, the processor may be configured to provide one or bothof a simulation signal and a test tone signal to the patient via one ormore electrodes. The system can include at least one sense electrodeconfigured to receive a sense signal from the patient. In some examples,the system includes an amplifier for amplifying the sense signal and aprocessor configured to receive an amplified signal from the amplifier.The processor can be configured to determine the magnitude of the testfrequency in the amplified signal and compare the magnitude to athreshold. If the magnitude falls below the threshold, the processor maybe configured to lower the gain of the at least one amplifier. In somesystems, the stimulation signal and test tone signal may be appliedsimultaneously while receiving a sense signal. In some examples, thetest tone signal may be applied during a sensing procedure withoutstimulation being applied. Systems may include additional or alternativecomponents to a test tone for determining the reliability of a sensed orprocessed signal.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1 is a conceptual diagram illustrating an example of a deep brainstimulation (DBS) system.

FIG. 2 is a functional block diagram illustrating components of anexample medical device.

FIG. 3 is an example spectrogram of a bioelectrical brain signal sensedwithin a brain of a patient.

FIG. 4 is a conceptual power spectral density plot of bioelectricalsignals in a DBS system in which saturation is present.

FIG. 5 is a conceptual power spectral density plot of bioelectricalsignals in a DBS system free from saturation.

FIG. 6 is a flow diagram illustrating an exemplary technique fordetecting and addressing saturation in a DBS system.

DETAILED DESCRIPTION

FIG. 1 is a conceptual diagram illustrating an example nervous interfacesystem 10 that electrically interfaces with the nervous system of apatient. In some examples, the nervous interface system 10 includes atherapy system that delivers therapy to control a patient condition,such as a movement disorder or a neurodegenerative impairment of patient12. In other examples, the interface system 10 can be used as adiagnostic instrument for receiving electrical signals from the nervoustissue of the patient 12. Patient 12 ordinarily will be a human patient.In some cases, however, therapy system 10 may be applied to othermammalian or non-mammalian non-human patients. While movement disordersand neurodegenerative impairment are primarily referred to herein, inother examples, therapy system 10 may provide therapy to manage symptomsof other patient conditions, such as, but not limited to, seizuredisorders, neurodegenerative impairment or psychological disorders.

A movement disorder or other neurodegenerative impairment may includesymptoms such as, for example, muscle control impairment, motionimpairment or other movement problems, such as rigidity, bradykinesia,rhythmic hyperkinesia, nonrhythmic hyperkinesia, and akinesia. In somecases, the movement disorder may be a symptom of Parkinson's disease.However, the movement disorder may be attributable to other patientconditions.

The interface system 10 includes medical device programmer 14,implantable medical device (IMD) 16, lead extension 18, and leads 20Aand 20B with respective sets of electrodes 24, 26. In the example shownin FIG. 1, electrodes 24, 26 of leads 20A, 20B are positioned tointerface with a tissue site within brain 28, such as a deep brain siteunder the dura mater of brain 28 of patient 12. In some examples,electrodes can be configured to interface with one or more regions ofbrain 28, such as the subthalamic nucleus, globus pallidus or thalamus.Stimulation system can be configured to deliver electrical stimulationto such regions, which may be an effective treatment to manage movementdisorders, such as Parkinson's disease. It will be appreciated that infurther examples, interface system 10 can be positioned to interfacewith a nervous tissue site in a region separate from the patient'sbrain, or with other physiological systems of the patient such as themuscular system.

In the illustrated embodiment, IMD 16 includes a therapy module thatincludes a stimulation generator that may generate and deliverelectrical stimulation therapy to patient 12 via a subset of electrodes24, 26 of leads 20A and 20B, respectively. The subset of electrodes 24,26 that are used to deliver electrical stimulation to patient 12, and,in some cases, the polarity of the subset of electrodes 24, 26, may bereferred to as a stimulation electrode combination. It will beappreciated that in other embodiments, such as in an exemplarydiagnostic instrument, IMD 16 need not include a therapy module.

The IMD 16 can include a sensing module 46 configured to sensebioelectrical or other electrical signals within the brain 28 via asubset of electrodes 24, 26 of leads 20A and 20B, respectively. Whiletwo leads 20A, 20B are shown in the illustrated embodiment, it will beappreciated that embodiments of the invention are not limited to twoleads, but may include any appropriate number of leads. For example,various embodiments can include a single lead having a plurality ofelectrodes or a plurality of leads each having at least one electrode.Generally, each lead of a plurality of leads need not include the samenumber of electrodes. The subset of electrodes 24, 26 that are used tosense such signals within the brain 28 may be referred to as senseelectrodes, a sense electrode combination, or at least one senseelectrode. Examples of bioelectrical brain signals include, but are notlimited to, electrical signals generated from local field potentialswithin one or more regions of brain 28, an electroencephalogram (EEG)signal or an electrocorticogram (ECoG) signal.

In stimulation systems, electrical stimulation generated by IMD 16 maybe configured to manage a variety of disorders and conditions. In someexamples, the stimulation generator of IMD 16 is configured to generateand deliver electrical pulses to patient 12 via electrodes of a selectedstimulation electrode combination. However, in other examples, thestimulation generator of IMD 16 may be configured to generate anddeliver a continuous wave signal, e.g., a sine wave or triangle wave. Ineither case, a signal generator within IMD 16 may generate theelectrical stimulation therapy for DBS according to a therapy programthat is selected at that given time in therapy. In examples in which IMD16 delivers electrical stimulation in the form of stimulation pulses, atherapy program may include a set of therapy parameter values, such as astimulation electrode combination for delivering stimulation to patient12, pulse frequency, pulse width, and a current or voltage amplitude ofthe pulses. As previously indicated, the stimulation electrodecombination may indicate the specific electrodes 24, 26 that areselected to deliver stimulation signals to tissue of patient 12 and therespective polarity of the selected electrodes.

In some examples, stimulation signals can include signal componentslocated within one or more frequency ranges (e.g., within a firstfrequency band). In some examples, the stimulation signals can includecomponents in multiple frequency bands. For instance, a signal having acomponent with frequency F may comprise signal components havingfrequencies at one or both of harmonics and sub-harmonics of F. In someembodiments, the stimulation signal can include components locatedwithin a first frequency range. In some such examples, the firstfrequency range may include any combination of a primary stimulationfrequency, one or more harmonics, and one or more sub-harmonics.Additionally or alternatively, the first frequency range may includefirst frequency ranges, wherein the frequency content of a signal mayinclude components in one or more overlapping or disjoint ranges.

In various embodiments, IMD 16 may be implanted within a subcutaneouspocket above the clavicle, or, alternatively, the abdomen, back orbuttocks of patient 12, on or within cranium 32 or at any other suitablesite within patient 12. Generally, IMD 16 is constructed of abiocompatible material that resists corrosion and degradation frombodily fluids. IMD 16 may comprise a hermetic housing to substantiallyenclose components, such as a processor, therapy module, and memory.

Implanted lead extension 18 is coupled to IMD 16 via connector 30. Inthe example of FIG. 1, lead extension 18 traverses from the implant siteof IMD 16 and along the neck of patient 12 to cranium 32 of patient 12to access brain 28. In the example shown in FIG. 1, leads 20A and 20B(collectively “leads 20”) are implanted within the right and lefthemispheres, respectively, of patient 12 in order deliver electricalstimulation to one or more regions of brain 28, which may be selectedbased on the patient condition or disorder controlled by therapy system10. Other lead 20 and IMD 16 implant sites are contemplated. Forexample, IMD 16 may be implanted on or within cranium 32, in someexamples. Or leads 20 may be implanted within the same hemisphere or IMD16 may be coupled to a single lead.

Although leads 20 are shown in FIG. 1 as being coupled to a common leadextension 18, in other examples, leads 20 may be coupled to IMD 16 viaseparate lead extensions or directly to connector 30. In an exemplarystimulating system interfacing with a patient's brain, leads 20 may bepositioned to deliver electrical stimulation to one or more targettissue sites within brain 28 to manage patient symptoms associated witha movement disorder of patient 12. Leads 20 may be implanted to positionelectrodes 24, 26 at desired locations of brain 28 through respectiveholes in cranium 32. Leads 20 may be placed at any location within brain28 such that electrodes 24, 26 are capable of providing electricalstimulation to target tissue sites within brain 28 during treatment. Forexample, electrodes 24, 26 may be surgically implanted under the duramater of brain 28 or within the cerebral cortex of brain 28 via a burrhole in cranium 32 of patient 12, and electrically coupled to IMD 16 viaone or more leads 20.

Example techniques for delivering therapy to manage a movement disorderare described in U.S. Pat. No. 8,121,694, entitled, “THERAPY CONTROLBASED ON A PATIENT MOVEMENT STATE,” which was filed on Sep. 25, 2008,which is incorporated herein by reference in its entirety. In someexamples described by U.S. patent application Ser. No. 12/237,799 toMolnar et al., a brain signal, such as an EEG or ECoG signal, may beused to determine whether a patient is in a movement state or a reststate. The movement state includes the state in which the patient isgenerating thoughts of movement (i.e., is intending to move), attemptingto initiate movement or is actually undergoing movement. The movementstate or rest state determination may then be used to control therapydelivery. For example, upon detecting a movement state of the patient,therapy delivery may be activated in order to help patient 12 initiatemovement or maintain movement, and upon detecting a rest state ofpatient 12, therapy delivery may be deactivated or otherwise modified.

In the example shown in FIG. 1, electrodes 24, 26 of leads 20 are shownas ring electrodes. Ring electrodes may be used in patient interfaceapplications because they are relatively simple to program and arecapable of electrically communicating with any tissue adjacent toelectrodes 24, 26. For instance, in a stimulation system interfacingwith a patient's brain, ring electrodes are capable of delivering anelectrical field to any tissue adjacent to electrodes 24, 26. In otherexamples, electrodes 24, 26 may have different configurations. Forexamples, in some examples, at least some of the electrodes 24, 26 ofleads 20 may have a complex electrode array geometry that is capable ofproducing shaped electrical fields. The complex electrode array geometrymay include multiple electrodes (e.g., partial ring or segmentedelectrodes) around the outer perimeter of each lead 20, rather than onering electrode. As discussed, additionally or alternatively, the systemcan include a number other than two leads 20, each including more orfewer electrodes than shown.

In this manner, electrical stimulation may be directed to a specificdirection from leads 20 to enhance therapy efficacy and reduce possibleadverse side effects from stimulating a large volume of tissue. In someexamples, a housing of IMD 16 may include one or more stimulation and/orsensing electrodes. In alternative examples, leads 20 may have shapesother than elongated cylinders as shown in FIG. 1. For example, leads 20may be paddle leads, spherical leads, bendable leads, or any other typeof shape effective in treating patient 12.

In general, the subsets of electrodes 24, 26 that are used asstimulation electrodes and as sense electrodes can be selected by avariety of selection processes, some of which are described in thecommonly-assigned U.S. Pat. No. 8,428,733 to Carlson et al., entitled,“STIMULATION ELECTRODE SELECTION,” which was filed on Sep. 21, 2009 andis incorporated herein by reference in its entirety. In someembodiments, any electrodes 24, 26 or electrode combinations, includingan electrode on the housing of IMD 16, are capable of providingelectrical signals to and receiving signals from the brain 28 or othernervous tissue of the patient. In other embodiments, such as diagnosticsystems, electrodes 24, 26 or electrode combinations can be capable ofreceiving signals from proximate nervous tissue of the patient.

External programmer 14 wirelessly communicates with IMD 16 as needed toprovide or retrieve therapy or diagnostic information. Programmer 14 isan external computing device that the user, e.g., the clinician and/orpatient 12, may use to communicate with IMD 16. For example, programmer14 may be a clinician programmer that the clinician uses to communicatewith IMD 16 and program one or more therapy programs for IMD 16.Alternatively, programmer 14 may be a patient programmer that allowspatient 12 to select programs and/or view and modify therapy parameters.The clinician programmer may include more programming features than thepatient programmer. In other words, more complex or sensitive tasks mayonly be allowed by the clinician programmer to prevent an untrainedpatient from making undesired changes to IMD 16.

Programmer 14 may be a hand-held computing device with a displayviewable by the user and an interface for providing input to programmer14 (i.e., a user input mechanism). For example, programmer 14 mayinclude a small display screen (e.g., a liquid crystal display (LCD) ora light emitting diode (LED) display) that presents information to theuser. In addition, programmer 14 may include a touch screen display,keypad, buttons, a peripheral pointing device or another input mechanismthat allows the user to navigate through the user interface ofprogrammer 14 and provide input. If programmer 14 includes buttons and akeypad, the buttons may be dedicated to performing a certain function,i.e., a power button, or the buttons and the keypad may be soft keysthat change in function depending upon the section of the user interfacecurrently viewed by the user. Alternatively, the screen (not shown) ofprogrammer 14 may be a touch screen that allows the user to provideinput directly to the user interface shown on the display. The user mayuse a stylus or their finger to provide input to the display.

In other examples, programmer 14 may be a larger workstation or aseparate application within another multi-function device, rather than adedicated computing device. For example, the multi-function device maybe a notebook computer, tablet computer, workstation, cellular phone,personal digital assistant or another computing device that may run anapplication that enables the computing device to operate as medicaldevice programmer 14. A wireless adapter coupled to the computing devicemay enable secure communication between the computing device and IMD 16.

When programmer 14 is configured for use by the clinician, programmer 14may be used to transmit initial programming information to IMD 16. Thisinitial information may include hardware information, such as the typeof leads 20 and the electrode arrangement, the position of leads 20within brain 28, the configuration of electrode array 24, 26, initialprograms defining therapy parameter values, and any other informationthe clinician desires to program into IMD 16. Programmer 14 may also becapable of completing functional tests (e.g., measuring the impedance ofelectrodes 24, 26 of leads 20).

In therapeutic stimulation systems, the clinician may also store therapyprograms within IMD 16 with the aid of programmer 14. During aprogramming session, the clinician may determine one or more therapyprograms that may provide efficacious therapy to patient 12 to addresssymptoms associated with a patient condition, such as a movementdisorder. In some examples, the programs may deliver stimulation in aclosed-loop manner, such as in response to one or more different patientstates, such as a sleep state, movement state or rest state. Forexample, in stimulation systems, the clinician may select one or morestimulation electrode combinations with which stimulation is deliveredto brain 28. During the programming session, patient 12 may providefeedback to the clinician as to the efficacy of the specific programbeing evaluated or the clinician may evaluate the efficacy based on oneor more physiological parameters of patient (e.g., muscle activity ormuscle tone). Programmer 14 may assist the clinician in thecreation/identification of therapy programs by providing a methodicalsystem for identifying potentially beneficial therapy parameter values.

Programmer 14 may also be configured for use by patient 12. Whenconfigured as a patient programmer, programmer 14 may have limitedfunctionality (compared to a clinician programmer) in order to preventpatient 12 from altering critical functions of IMD 16 or applicationsthat may be detrimental to patient 12. In this manner, programmer 14 mayonly allow patient 12 to adjust values for certain therapy parameters orset an available range of values for a particular therapy parameter.

Programmer 14 may also provide an indication to patient 12 when therapyis being delivered, when patient input has triggered a change in therapyor when the power source within programmer 14 or IMD 16 needs to bereplaced or recharged. For example, programmer 14 may include an alertLED, may flash a message to patient 12 via a programmer display,generate an audible sound or somatosensory cue to confirm patient inputwas received, e.g., to indicate a patient state or to manually modify atherapy parameter.

Whether programmer 14 is configured for clinician or patient use,programmer 14 is configured to communicate to IMD 16 and, optionally,another computing device, via wireless communication. Programmer 14, forexample, may communicate via wireless communication with IMD 16 usingradio frequency (RF) telemetry techniques known in the art. Programmer14 may also communicate with another programmer or computing device viaa wired or wireless connection using any of a variety of local wirelesscommunication techniques, such as RF communication according to the802.11 or Bluetooth specification sets, infrared (IR) communicationaccording to the IRDA specification set, or other standard orproprietary telemetry protocols. Programmer 14 may also communicate withother programming or computing devices via exchange of removable media,such as magnetic or optical disks, memory cards or memory sticks.Further, programmer 14 may communicate with IMD 16 and anotherprogrammer via remote telemetry techniques known in the art,communicating via a local area network (LAN), wide area network (WAN),public switched telephone network (PSTN), or cellular telephone network,for example.

In some examples, a therapy system may be implemented to provide chronicstimulation therapy to patient 12 over the course of several months oryears. However, a therapy system may also be employed on a trial basisto evaluate therapy before committing to full implantation. Ifimplemented temporarily, some components of stimulation system may notbe implanted within patient 12. For example, patient 12 may be fittedwith an external medical device, such as a trial stimulator, rather thanIMD 16. The external medical device may be coupled to percutaneous leadsor to implanted leads via a percutaneous extension. If the trialstimulator indicates the stimulation system provides effective treatmentto patient 12, the clinician may implant a chronic stimulator withinpatient 12 for relatively long-term treatment

In other examples, an interface system 10 may be implemented fordiagnostic or monitoring purposes over a period of time. A temporarysystem may be used for a patient undergoing a one-time diagnosticprocedure. However, if a patient will require repeated or periodicmonitoring, a purely diagnostic system 10 may be implanted. In somefurther examples, an implanted system for diagnostic purposes may bereprogrammed, for example, by programmer 14, to enable a stimulationprogram to operate via the implanted system.

FIG. 2 is a functional block diagram illustrating components of anexample IMD 16 for a stimulating system. In the example shown in FIG. 2,IMD 16 includes processor 40, memory 42, stimulation generator 44,sensing module 46, switch module 48, telemetry module 50, and powersource 52. Memory 42 may include any volatile or non-volatile media,such as a random access memory (RAM), read only memory (ROM),non-volatile RAM (NVRAM), electrically erasable programmable ROM(EEPROM), flash memory, and the like. Memory 42 may storecomputer-readable instructions that, when executed by processor 40,cause IMD 16 to perform various functions.

As previously discussed, in the example shown in FIG. 2, memory 42 maystore therapy programs 54, sense electrode combinations and associatedstimulation electrode combinations 56, and operating instructions 58 inseparate memories within memory 42 or separate areas within memory 42.In other cases, sense and stimulation electrode combinations need not beassociated with one another. In addition, in some examples, memory 42may store a bioelectrical brain signal sensed via at least some of thestored sense electrode combinations and/or one or more frequency bandcharacteristics of the bioelectrical brain signals. Each stored therapyprogram 52 defines a particular program of therapy in terms ofrespective values for electrical stimulation parameters, such as astimulation electrode combination, electrode polarity, current orvoltage amplitude, pulse width, and pulse rate. In some examples, thetherapy programs may be stored as a therapy group, which defines a setof therapy programs with which stimulation may be generated. Thestimulation signals defined by the therapy programs of the therapy groupmay be delivered together on an overlapping or non-overlapping (e.g.,time-interleaved) basis.

Sense and stimulation electrode combinations 56 stores sense electrodecombinations and associated stimulation electrode combinations. Asdescribed above, in some examples, the sense and stimulation electrodecombinations may include the same subset of electrodes 24, 26, or mayinclude different subsets of electrodes. Stimulation may be delivered ina bi-polar manner between two or more electrodes 24, 26 on leads 20, ormay instead be delivered in a unipolar manner between an electrode onleads 20 and a common reference point. In some examples, the housing (or“can”) of IMD 16 can function as a common reference. Similarly, sensingmay be performed in a bi-polar manner between two electrodes 24, 26 onleads 20, or in a unipolar manner between an electrode 24, 26 on leads20 and a common reference point such as the housing of IMD 16. Operatinginstructions 58 guide general operation of IMD 16 under control ofprocessor 40, and may include instructions for measuring the impedanceof electrodes 24, 26 and/or determining the distance between electrodes24, 26.

Stimulation generator 44, under the control of processor 40, generatesstimulation signals for delivery to patient 12 via selected combinationsof electrodes 24, 26. An example range of electrical stimulationparameters believed to be effective in DBS to manage a movement disorderof patient include:

1. Frequency: the stimulation signal can include signal componentswithin a first range of frequencies, for example, between approximately0 Hz and approximately 500 Hz, between approximately 100 Hz andapproximately 500 Hz, between approximately 120 Hz and approximately 200Hz.

2. Voltage Amplitude: between approximately 0.1 volts and approximately50 volts, such as between approximately 0.5 volts and approximately 20volts, or approximately 5 volts.

3. Current Amplitude: A current amplitude may be defined as thebiological load in which the voltage is delivered. In acurrent-controlled system, the current amplitude, assuming a lower levelimpedance of approximately 500 ohms, may be between approximately 0.2milliAmps to approximately 100 milliAmps, such as between approximately1 milliAmps and approximately 40 milliAmps, or approximately 10milliAmps. However, in some examples, the impedance may range betweenabout 200 ohms and about 2 kiloohms.

4. Pulse Width: between approximately 10 microseconds and approximately5000 microseconds, such as between approximately 100 microseconds andapproximately 1000 microseconds, or between approximately 180microseconds and approximately 450 microseconds.

Accordingly, in some examples, stimulation generator 44 may generateelectrical stimulation signals in accordance with the electricalstimulation parameters noted above. Other ranges of therapy parametervalues may also be useful, and may depend on, for example, one or bothof the therapy being provided and the target stimulation site withinpatient 12, which may or may not be within brain 28. While stimulationpulses are described, stimulation signals may be of any form, such ascontinuous-time signals (e.g., sine waves) or the like. In general, astimulation signal may include any arbitrarily shaped waveform. In someexamples, the efficacy of the stimulation waveform may be dependent onthe location in the patient's body, the contact with the patient'snervous tissue, or other factors. In some embodiments, the waveform ofthe stimulation signal may be selected based on particular factors of apatient.

Processor 40 may include any one or more of a microprocessor, acontroller, a digital signal processor (DSP), an application specificintegrated circuit (ASIC), a field-programmable gate array (FPGA),discrete logic circuitry, and the functions attributed to processor 40herein may be embodied as firmware, hardware, software or anycombination thereof. Processor 40 controls stimulation generator 44according to therapy programs 52 stored in memory 42 to apply particularstimulation parameter values specified by one or more of programs, suchas amplitude, pulse width, and pulse rate. In general, as used herein,the processor may be configured to perform actions such as providing orreceiving signals, pulses, and the like. In various embodiments, theprocessor 40 is capable of performing such functions directly.Additionally or alternatively, the processor 40 may perform such actionsindirectly by causing another component, such as stimulation generator44 or the like, to perform such functions. In some examples, theprocessor is configured to perform such actions based in instructionslocated in memory 42. Additionally or alternatively, processor 40 mayinclude internal or dedicated memory separate from memory 42.

In the example shown in FIG. 2, the set of electrodes 24 includeselectrodes 24A, 24B, 24C, and 24D, and the set of electrodes 26 includeselectrodes 26A, 26B, 26C, and 26D. In some embodiments, adjacentelectrodes (e.g., 24A, 24B) are separated by at least 1 millimeter (mm),and in some embodiments, at least 1.5 mm. Processor 40 also controlsswitch module 48 to apply the stimulation signals generated bystimulation generator 44 to selected combinations of electrodes 24, 26.In particular, switch module 48 may couple stimulation signals toselected conductors within leads 20, which, in turn, deliver thestimulation signals across selected electrodes 24, 26. Switch module 48may be a switch array, switch matrix, multiplexer, or any other type ofswitching module configured to selectively couple stimulation energy toselected electrodes 24, 26 and to selectively sense bioelectrical brainsignals with selected electrodes 24, 26. Hence, stimulation generator 44is coupled to electrodes 24, 26 via switch module 48 and conductorswithin leads 20. In some examples, however, IMD 16 does not includeswitch module 48. As described, in some examples, IMD 16 does notinclude stimulation generator 44, and is configured for monitoring anddiagnostic purposes.

Stimulation generator 44 may be a single channel or multi-channelstimulation generator. In particular, stimulation generator 44 may becapable of delivering, a single stimulation pulse, multiple stimulationpulses or continuous signal at a given time via a single electrodecombination or multiple stimulation pulses at a given time via multipleelectrode combinations. In some examples, however, stimulation generator44 and switch module 48 may be configured to deliver multiple channelson a time-interleaved basis. For example, switch module 48 may serve totime divide the output of stimulation generator 44 across differentelectrode combinations at different times to deliver multiple programsor channels of stimulation energy to patient 12.

Sensing module 46, under the control of processor 40, may sensebioelectrical brain signals and provide the sensed bioelectrical brainsignals to processor 40. Processor 40 may control switch module 48 tocouple sensing module 46 to a selected combinations of electrodes 24,26, i.e., a sense electrode combination. In this way, IMD 16 isconfigured such that sensing module 46 may sense bioelectrical brainsignals with a plurality of different sense electrode combinations.Switch module 48 may be electrically coupled to the selected electrodes24, 26 via the conductors within the respective leads 20, which, inturn, deliver the bioelectrical brain signal sensed across the selectedelectrodes 24, 26 to sensing module 46. The bioelectrical brain signalmay include electrical signals that are indicative of electricalactivity within brain 28 of patient 12.

Although sensing module 46 is incorporated into a common housing withstimulation generator 44 and processor 40 in FIG. 2, in other examples,sensing module 46 may be in a separate housing from IMD 16 and maycommunicate with processor 40 via wired or wireless communicationtechniques. Example bioelectrical brain signals include, but are notlimited to, a signal generated from local field potentials within one ormore regions of brain 28. EEG and ECoG signals are examples of localfield potentials that may be measured within brain 28. However, localfield potentials may include a broader genus of electrical signalswithin brain 28 of patient 12.

Telemetry module 50 supports wireless communication between IMD 16 andan external programmer 14 or another computing device under the controlof processor 40. Processor 40 of IMD 16 may receive, as updates toprograms, values for various stimulation parameters such as amplitudeand electrode combination, from programmer 14 via telemetry module 50.The updates to the therapy programs may be stored within therapyprograms 54 portion of memory 42. Telemetry module 50 in IMD 16, as wellas telemetry modules in other devices and systems described herein, suchas programmer 14, may accomplish communication by radiofrequency (RF)communication techniques. In addition, telemetry module 50 maycommunicate with external medical device programmer 14 via proximalinductive interaction of IMD 16 with programmer 14. Accordingly,telemetry module 50 may send information to external programmer 14 on acontinuous basis, at periodic intervals, or upon request from IMD 16 orprogrammer 14.

Power source 52 delivers operating power to various components of IMD16. Power source 52 may include a small rechargeable or non-rechargeablebattery and a power generation circuit to produce the operating power.Recharging may be accomplished through proximal inductive interactionbetween an external charger and an inductive charging coil within IMD16. In some examples, power requirements may be small enough to allowIMD 16 to utilize patient motion and implement a kineticenergy-scavenging device to trickle charge a rechargeable battery. Inother examples, traditional batteries may be used for a limited periodof time.

The foregoing discusses various stimulation parameters used to deliverstimulation, including the frequency of the stimulation waveform, whichmay be, in one example, any frequency between 0 Hz and 500 Hz (e.g., inone specific example 130 Hz). Such a stimulation signal or waveform maycomprise frequency components at a variety of frequencies. For instance,a pulsatile signal delivered at 130 Hz may comprise signal componentsincluding a primary frequency of 130 Hz and various harmonics orsub-harmonics of the primary frequency component. As will beappreciated, in some embodiments, any of a variety of signal shapes orwaveforms having a primary frequency may be used.

It will be appreciated that, as referenced herein, a stimulation signal“including a stimulation frequency” refers to frequency content of thestimulation signal unless otherwise specified. That is, a signal applied“at a stimulation frequency” refers to a stimulation signal havingfrequency content including that stimulation frequency. As describedherein, applying a stimulation signal at a stimulation frequency withina first frequency range or band does not preclude the stimulation signalfrom having frequency content outside of the first frequency range. Thatis, if a stimulation signal comprises a primary frequency, F, within afirst frequency range or frequency band, the stimulation signal mayinclude harmonics or sub-harmonics of F that need not fall within thefirst frequency range. The stimulation signal may additionally oralternatively comprise frequency content outside of the first range offrequencies that is not a harmonic or sub-harmonic of F withoutdeparting from the scope of the disclosure.

In some instances, sense signals received by the sensing module 46 caninclude signals of interest within a second range of frequencies that isseparate from the first range of frequencies including components of thestimulation signal. In some embodiments, the signals of interest in thesense signals can include signals within the beta band. The beta bandmay include a frequency range of about 10 Hertz (Hz) to about 35 Hz,such as about 10 Hz to about 30 Hz or 13 Hz to about 30 Hz. Othersignals of interest can include additional or alternative frequencybands, such as delta (e.g., less than approximately 4 Hz), theta (e.g.,between approximately 4 Hz and approximately 8 Hz), alpha (e.g., betweenapproximately 8 Hz and approximately 13 Hz), gamma (e.g., betweenapproximately 35 Hz and approximately 100 Hz), or other knownneurological frequency bands. In some examples, signals of interest arenot limited to any one neurological frequency band, but can moregenerally be contained within a second frequency band which includes arange of frequencies overlapping with at least one neurologicalfrequency band.

Signals of interest can include a variety of frequency bands accordingto the patient and the patient's condition. For instance, for certainpatients (e.g., patients with Parkinson's disease), signals in the betafrequency band can be of particular interest to a clinician or physicianobserving the sense signals. However, neural signals can have arelatively low magnitude, for example in the microvolt (μV) range, andas a result can be difficult to analyze. Accordingly, in some examples,the sensing module 46 can include a signal chain comprising a variety ofcomponents for processing the signals received from one or more sensingelectrodes or sense electrode combinations. For example, the sensingmodule 46 can include one or more pre-amplifiers, amplifiers, filters,analog-to-digital converters (ADC's), and the like. Such components canassist in the analysis of the sensed signals of interest by improving ormaximizing the fidelity of the sensed signals. In some cases, thisprocessing includes processing the sensed signal to extract signalcomponents within one or more frequency bands of interest.

As described previously, a stimulation signal can be applied to apatient's brain or other tissue at one or more stimulation frequencieswithin a first range of frequencies. According to various therapyparameters, various properties of stimulation signals may include selectelectrode combination and polarity, pulse amplitude, pulse width, dutycycle, and frequency. In various treatment programs, stimulation pulsesare intended to affect the bioelectrical signals in the patient, such asto suppress or promote such signals. For example, a stimulation signalcan be applied to the patient's brain via at least one stimulationelectrode (e.g., a unipolar stimulation electrode, a stimulationelectrode combination, etc.) comprising one or more frequencies in orderto achieve some physiological effect. This physiological effect may beindicated by a change in the frequency content of a sensed signal, suchas a reduction in magnitude of the frequency content in one or morefrequency ranges. For instance, a sensed signal in the time domain maybe converted to the frequency domain so that the spectral power densitywithin various frequencies bands within that time domain signal can bedetermined. In some examples, the power of the signal in the beta bandmay be an indication of the efficacy of stimulation for patient'ssuffering from some movement disorders. Stimulation may affect (e.g.,reduce) the power of the signal in the beta band for such patients.

Accordingly, it can be advantageous to monitor the bioelectrical signalswithin the patient's brain or other nervous tissue while simultaneouslyapplying a stimulation signal in order to observe the effect of one onthe other. That is, sensing the sense signal from at least one sensingelectrode while simultaneously applying a stimulation signal via atleast one stimulation electrode can provide real time feedback of theefficacy of the applied stimulation signal. In addition, simultaneouslymonitoring sense signals while applying stimulation signals can provideinformation regarding the level of stimulation required for effectivepromotion or suppression of signals of interest as well as indicatepotential side effects of the stimulation on the patient.

In some cases, the stimulation signal may be such that one or morefrequency components thereof are outside of the frequency band ofinterest for sensing so that stimulation artifacts are not present, orare minimized, in the sensed signal. For instance, in some examples, thestimulation signal includes frequency components within a first range offrequencies that does not overlap with the second range of frequencies.This can be done in order to limit interference between the stimulationsignal and sensed signals of interest. By analyzing the frequencycontent of the resulting sense signal, signals of interest in the secondrange of frequencies can be analyzed independently from artifacts fromthe stimulation signal in the first range of frequencies. In otherinstances, the first and second frequency ranges may overlap, in whichstimulation signals may have similar frequency content as signals ofinterest.

As discussed, in some instances, the magnitude of signals of interest inthe sense signal, such as particular frequency components in secondrange of frequencies, for example, can be relatively small. The sensesignal can be processed to create a processed signal, which canfacilitate analysis of the signals of interest. For example, the sensingmodule 46 can include at least one amplifier for amplifying the receivedsense signal. In various embodiments, the at least one amplifier can beconfigured to amplify any portion of the sense signal. For example, theat least one amplifier can amplify the entire received sense signal oronly certain frequencies of the received sense signal, such as frequencycomponents of interest in the second frequency band. In the latter case,a band-pass filter may be used to extract the frequencies of thereceived sense signal that are of interest (e.g., the signal componentsresiding within the beta band). In some examples, amplification of thesense signal is a function of frequency of the received sense signal. Infurther examples, frequencies within the second range of frequencies areamplified more than the frequencies in the first range of frequencies.Additionally or alternatively, a transformation may be performed on thesense signal, such as a Fourier transform, to convert the signal to thefrequency domain so that specific frequency components can be analyzed,as is discussed further below.

Amplification of the sense signal can lead to increased ability toanalyze the efficacy of the stimulation signal on the patient. However,excessive amplification can result in the obscuring of data, renderingthe amplified sense signal unreliable. For example, if the amplificationof the sense signal is too high, the signal chain can become saturated,resulting in a potentially misleading processed signal. In someinstances, when saturation occurs, the processed signal might indicatethat the signals of interest are responding to stimulation as desiredwhen in reality the observed change in the processed signal is anartifact of the saturation and the patient is not actually receivingadequate treatment. In other instances, saturation may result indisguised changes in the signals of interest, leading to amisrepresentation that the patient is not receiving adequate treatment.To compensate for some such instances, aspects of the stimulation signalmay be unnecessarily adjusted beyond a desired magnitude in order toachieve observable changes in the signals of interest. In general,saturation can lead to a variety of undesirable circumstances, such as alack of therapy provided to a patient, an abundance of unnecessarytherapy provided to the patient, which can drain the power sourceunnecessarily or lead to side effects in the patient, or a generallyunusable signal from which a conclusion cannot be reached.

Accordingly, it can be advantageous to determine when saturation of thesignal chain occurs so that it is known that the processed signal isunreliable and measures can be taken to eliminate the saturation. Insome cases, it can be determined that the signal chain is saturatedbased on operating characteristics of components in the signal chain.For instance, saturation may be evidenced by a pre-amp being over rangeor by problems in a slew rate of an analog-to-digital converter (ADC).In some embodiments, the system (e.g., via the processor 40 or othercomponents of the IMD 16) can automatically perform at least one actionin response to a detected saturation. Such actions can include, in someexamples, any combination of placing the system in a safe mode in whichone or more system actions (e.g., applying a stimulation pulse) aredisabled, reducing the gain of at least one amplifier, adjusting theoperation of one or more additional signal chain components, adjustingat least one property of the stimulation signal, adjusting which ofelectrodes 24, 26 are used as stimulating and sensing electrodes,adjusting the impedance of at least one sensing electrode as describedin patent application Ser. No. 14/726,028 entitled “IMPEDANCE MATCHINGAND ELECTRODE CONDITIONING IN PATIENT INTERFACE SYSTEMS,” filed May 29,2015, which is hereby incorporated herein by reference in its entirety,storing an indication in memory indicating potential saturation for usein analyzing any stored sensed signal, and/or providing somenotification to a user (e.g., a clinician or patient). In some examples,a combination of actions can be performed. For example, in response todetected saturation, the system can enter a safe mode while adjustingthe gain of an amplifier in the signal chain. Once the amplification isadjusted, the system may exit the safe mode and operate normally. Insome systems, in the event that lower the gain is not an effectivecourse of action for eliminating saturation, the system may remain insafe mode until appropriate action is taken. Automatic performance ofthe at least one action can be initiated, for example, according tooperating instructions 58 stored in memory 42 communicating with theprocessor 40.

In some embodiments, the electrodes 24, 26 of therapy system 10 caninclude at least one test electrode (or similarly, test electrodecombination) configured to apply a test tone signal to the patient'sbrain. The test tone electrode can receive a test signal from, forexample, the stimulation generator 44. In other examples, the IMD 16 caninclude a separate test tone module 50 configured to generate the testtone signal for application to the brain tissue via the test toneelectrode. The test tone signal can have a test tone frequency that isgenerally distinguishable from both a stimulation signal and sensedsignals of interest. For example, the test tone signal may include atest tone frequency that is not in the first range of frequencies(including the stimulation frequency) or the second range of frequencies(frequency content of signals of interest). For instance, in someembodiments, the stimulation signal can include a stimulation frequencycontent between approximately 120 Hz and 500 Hz (e.g., within a firstrange of frequencies; as described, various harmonics and sub-harmonicsof the stimulation frequency may depart from this range), the secondfrequency range can be between approximately zero Hz and 100 Hz, and thetest tone frequency can be approximately 105 Hz. It will be appreciatedthat in the present example, test tone frequencies between 100 Hz and120 Hz are appropriately not contained in the first or second frequencyranges and are also possible. It may also be that various harmonics andsub-harmonics of the test tone frequency may fall within one or both ofthe first and second frequency ranges. In still further embodiments, thetest tone can be within one of the first and second frequency bands yetdistinguishable from the stimulation signal or the signals of interestin the sense signal.

In some embodiments, the stimulation generator 44 is configured togenerate a stimulation signal having a built-in test tone signal. Thatis, the stimulation pulse can include a stimulation signal havingfrequencies within the first frequency band and a test tone frequencycomponent that is outside of the first frequency band. In suchembodiments, the test tone electrode can be the same electrode as thestimulation electrode (or stimulation electrodes or stimulationelectrode combination), and the test tone is provided by the stimulationgenerator 44.

The sense signal received by the sensing module can include frequencycontent having the test tone frequency resulting from the applied testtone signal. Because the test tone frequency is outside of the first andsecond frequency bands, the received sense signal (or the resultingprocessed signal from the signal chain) can include distinguishableinformation regarding the first frequency band, the second frequencyband and signals of interest contained therein, and the test tonefrequency.

During simultaneous stimulation and sensing, the test tone frequency canbe observed in addition to the signals of interest in the processedsignal. The test tone signal can be such that, in the event of signalchain saturation, the magnitude of the test tone frequency content ofthe processed signal decreases, and in some cases, sub-harmonics of thetest tone frequency are created. Accordingly, aspects of the processedsignal can be analyzed to determine the occurrence of saturation of thesignal chain. It will be appreciated that as described herein, analysisof the sense signal can include analysis of the processed signal and isnot limited to describing only an unprocessed signal received from senseelectrodes unless specifically stated.

The received sense signal can be processed and data from the sensedsignal can be saved in memory 42 for analysis. In some examples, datacan be captured over time and displayed as a spectrogram. FIG. 3 is anexample spectrogram of bioelectrical brain signals of a human subjectwhich shows the frequency content of the sensed time domain signal. Thiscan be generated in several ways, such as by applying a Fouriertransform to the sensed time domain signal or by processing the sensedtime domain signal using a series of bandpass filters. The y-axis of thespectrogram indicates the frequency band of the bioelectrical brainsignal, the x-axis indicates time, and the z-axis, which extendssubstantially perpendicular to the plane of the image of FIG. 3 and isgenerally represented by the color of the spectrogram, indicates a powerlevel of the bioelectrical brain signal. The spectrogram provides athree-dimensional plot of the energy of the frequency content of abioelectrical brain signal over time.

As shown in the exemplary spectrogram of FIG. 3, stimulation pulses 70,74 are applied at various times in a first frequency band 60. A testtone signal 64 is shown having a frequency component (e.g., a test tonefrequency) of approximately 105 Hz. Additional signals are at timespresent in a second frequency band 62. Such signals can correspond tobioelectrical signals in the patient's brain. Optionally, a distinctsynchronization pulse 66 is emitted to assist in temporal alignment ofdata across multiple sensing and application procedures.

The spectrograph of FIG. 3 can indicate to a clinician or other user theefficacy of treatment to a patient over a period of time. For instance,the spectrograph includes data from a first time period 68 betweenapproximately 50 seconds and 100 seconds during which a stimulationsignal 70 is applied having a frequency in a first frequency band 60.During the application of the stimulation signal 70, signals in a secondfrequency band 62, in this instance signals at approximately 10-20 Hz,are seemingly suppressed. In addition, during the application of thestimulation signal 70, the test tone frequency 64 remains present in thespectrograph, indicating that saturation has likely not occurred andthat the sense signal during that time period is reliable. Thus, thesignals in the second frequency band 62 were likely suppressed due tothe application of the stimulation signal 70. In another instance, thespectrograph includes data from a second time period 72, betweenapproximately 175 and 225 seconds, in which another stimulation signal74 is applied. During the second time period 72, the test tone frequency64 disappears from the sense signal, indicating that data from thesecond time period 72 may not be reliable due to signal chainsaturation.

As described, data from the spectrograph of FIG. 3 includes informationregarding time, frequency, and amplitude of sense signals. Subsets ofsuch data can be helpful for providing useful analysis. For example, aslice of a spectrograph in the x-z plane can provide informationregarding the magnitude of a particular frequency in the sense signalover time. Alternatively, a slice of the spectrograph in the y-z planecan provide the spectral content of the sense signal at a particulartime. FIGS. 4 and 5 are exemplary slices in the y-z plane of such aspectrograph, illustrating spectral content of a sense signal at asingle point in time.

FIG. 4 is a sample plot illustrating the frequency content of a sensesignal sensed during the application of stimulation pulses at varyingmagnitudes and corresponding adjustments in the processing of the sensesignal. The Y axis provides the amplitude of a sensed signal in uV/rtHz.In the illustrated example, the test tone frequency is approximately 105Hz, and the stimulation frequency has frequency content within the firstrange of frequencies (approximately 140 Hz). A first signal 102 is shownas having prominent peaks at 105 Hz (corresponding to the test tonefrequency 104) and 140 Hz (corresponding to the stimulation frequency110). Lower-frequency content (e.g., approximately 18 Hz) in theillustrated sense signal can include signals of interest, such as thebeta band component of the bioelectrical signals in the patient's brain.As shown, the test tone frequency 104 is clearly present in the firstsignal 102.

FIG. 4 includes a second signal 112 observed at a separate time thanfirst signal 102. The second signal 112 has a large peak at thestimulation frequency (approximately 140 Hz) and shows little activityin the second frequency band (e.g., approximately 0 Hz to 100 Hz).However, the second signal 112 does not have a clear peak at the testtone frequency 104 (approximately 105 Hz), indicating that saturationmay have occurred. Accordingly, an observed change from detectedactivity in the second frequency band in the first signal 102 to anabsence of detected activity in the second frequency band in the secondsignal 112 cannot be reliably attributed to suppression of the activityin the second frequency band because saturation has occurred.

As described, in some embodiments, the system can automatically performat least one action in response to detected saturation. Thus, the systemcan monitor the presence of the test frequency in the sense signal, and,in the event that the test frequency component of the sense signal dropsbelow a predetermined threshold, the system can detect saturation andautomatically perform at least one action. In various examples, when thetest frequency component falls below a predetermined threshold, thesystem can adjust at least one of the stimulation signal, the test tonesignal, and the processing of the sense signal (e.g., reducing the gainof at least one amplifier). Performing the at least one correctiveaction can result in the detection of the test frequency in the sensesignal, and accordingly an indication that other information from thesense signal is reliable.

As previously described, saturation of the signal chain can additionallyor alternatively result in the appearance of sub-harmonics of the testfrequency being present in the sense signal. Accordingly, in someembodiments, saturation of the signal chain can be detected by observingthe sub-harmonics of the test frequency present in the sense signal. Inthe event that a sub-harmonic (or in some embodiments, a combination ofsub-harmonics) exceeds a predetermined threshold, saturation isdetected. Similarly to the above embodiments, the detection ofsaturation can cause the system to perform at least one action.

It will be appreciated that, while a variety of methods for detectingsaturation have been described, any one method or combination of suchmethods can be employed by a system according to various embodiments.For example, a system can perform any combination of monitoringoperation of components of the signal chain, observing the testfrequency in the sense signal, and observing the sub-harmonics of thetest frequency present in the sense signal. In various embodiments, anyone such method can be used to detect saturation. In alternativeembodiments, saturation is detected when more than one such events isobserved. In general, saturation can be detected based on any individualor combination of appropriate methods, in some embodiments triggering atleast one corrective action such as those previously discussed.

Similar to FIG. 4, FIG. 5 is a sample plot illustrating the frequencycontent of a sense signal while simultaneous stimulation pulses ofvarying magnitudes are applied. However, in the stimulation events ofFIG. 5, saturation is avoided. As shown, as a variety of stimulationpulses are applied at a stimulation frequency (approximately 140 Hz)along with a test tone signal having a test tone frequency(approximately 105 Hz). The stimulation frequency and test tonefrequency are present in the processed sense signal. Sense signals alsohave frequency content in a second frequency band (e.g., approximately0-100 Hz, or approximately 10-30 Hz). In a first signal 120corresponding to a 0V stimulation pulse, a noticeable peak near 22 Hz isshown. A second signal 122 corresponding to a 1V stimulation pulse showsa reduction in the magnitude at the same frequency, as does a thirdsignal 124 corresponding to a 2V stimulation pulse. Finally, a fourthsignal 126 corresponding to a 3V stimulation pulse shows a minimal peakat the same frequency in the second frequency band (approximately 22Hz). Comparisons of the first 120 through fourth 126 signals indicatethat increasing the magnitude of the stimulation pulse from 0V to 3Vsuppresses bioelectrical signals in the second frequency band. Moreover,because the test tone frequency is clearly present in each of the first120 through fourth 126 signals, it is likely that the signal chain didnot saturate, and that the observed suppression in the second frequencyband while simultaneously applying a stimulation signal is reliable.

FIG. 6 is a process-flow diagram illustrating an exemplary processmonitoring saturation of a signal chain in a DBS system. The processincludes receiving a sense signal via a sense electrode (130). Ingeneral, as discussed, the sense electrode can include a singleelectrode, a plurality of electrodes, an electrode combination, or thelike. Some embodiments of the method include one or both of the steps ofapplying a stimulation pulse via a stimulation electrode (150) as shownby broken line 152, and applying a test tone signal via a test electrode(154) as shown by broken line 156. Similarly, the stimulation electrodeand the test electrode can include a single electrode, a plurality ofelectrodes, an electrode combination, or the like. In some embodiments,the test tone signal can be included in the stimulation pulse, asindicated by broken line 158. In some such embodiments, the stimulationelectrode(s) and the test electrode(s) can include some of all of thesame electrode(s). As previously described, the stimulation pulse can becontained in a first frequency band while the test tone signal caninclude a test tone frequency that is outside of the first frequencyband.

The process further includes processing the sense signal to produce aprocessed signal (132). Processing the signal can include steps of, forexample, filtering and amplifying the sense signal. Processing can alsoinclude performing a transform of the signal (e.g., a Fourier transform)such as to determine the amplitude of various frequency components ofthe signal. The process can include monitoring a reliability signalindicative of the reliability of the processed signal (134). Asdescribed, such a reliability signal can include the presence of a testtone frequency in the processed signal, the presence of sub-harmonics ofthe test tone frequency in the processed signal, or any of a variety ofattributes of components in the signal chain.

The system (e.g., via the processor 40) can determine whether or not thereliability signal meets a predetermined threshold (136). For instance,the system can determine if the test tone frequency has a magnitudebelow a predetermined level, if sub-harmonics of the test tone frequencyexceed a predetermined threshold, or if components of the signal chainhave attributes that meet predetermined thresholds. In one example, themagnitude may be the power level in a particular frequency or frequencyband in the processed signal. If it is determined that the reliabilitysignal does not meet a predetermined threshold, the system continues tomonitor the reliability signal (134) and determines that the data in theprocessed signal is reliable (140).

On the other hand, if it is determined that the reliability signal doesmeet a predetermined threshold, the system can automatically perform atleast one action (142). Performing the at least one action can act toadjust the processed signal so that the reliability signal does not meetthe threshold. Performing the at least one action can include, forexample, placing the system in a safe mode, adjusting the gain of anamplifier in the signal chain, adjusting the stimulation signal,adjusting the test tone signal, or adjusting at least one additional oralternative aspect of the stimulation or the sensing modules. As shownin the illustrated diagram of FIG. 6, since performing the at least oneaction can result in adjusting the processing of the sense signal, thesystem can, after performing the at least one action, process the sensesignal (132). In other embodiments, in the event the processing step isnot changed, the system can, after performing the at least one action,continue to monitor the reliability signal (134).

It will be appreciated that the process illustrated in the diagram ofFIG. 6 is exemplary and does not represent every possible method ofcarrying out or utilizing the invention. Rather, various steps in theprocess can be omitted, permuted, or performed substantiallysimultaneously without departing from the scope of the invention. Forexample, in some embodiments, the system may apply a test tone signalvia a test electrode (154) and receive sense signals via sense electrode(130), process the received sense signal and compare a reliabilitysignal to a threshold to ensure that pre-therapy measurements arereliable prior to applying a stimulation pulse. Additionally oralternatively, a variety of threshold comparisons may be used to analyzethe reliability signal. In various embodiments, saturation may bedetected if a particular signal drops below a predetermined thresholdlevel, rises above a predetermined threshold level, or meets apredetermined threshold level. That is, “meeting a threshold” does notrequire that a reliability signal increases beyond a certain point. Forinstance, in some embodiments, a reliability signal meets a thresholdand results in the system automatically performing at least one actionwhen the magnitude of the test tone frequency falls to or below apredetermined threshold. In general, any appropriate reliability signalcomparison may be used.

In addition, the system can perform additional steps based on a varietyof determinations during the execution of the process of FIG. 6. In someembodiments, in the event that the system determines that the signalchain is saturated, the system can automatically perform at least oneaction and save the at least one action performed in memory 42. Forexample, in the event that saturation is detected, the system can reducethe gain of at least one amplifier in the signal chain, and save therelevant gain information (e.g., combinations of the previous gain, newgain, gain change, etc.) to memory 42.

In some embodiments, the system can perform a calibration step prior tooperation. In such a process, the system can monitor the processed sensesignal for evidence of saturation, and adjust the gain of at least oneamplifier in the signal chain until the system determines the maximumgain without inducing saturation of the signal chain. The maximum gaincan be saved to memory 42 and used as a starting gain for subsequenttherapy procedures. In some examples, a gain value saved in memory canbe applied at the start of all future therapy sessions. In otherexamples, the gain value can be applied for a set number of therapysessions before another calibration is performed. In still furtherembodiments, a calibration step can be performed at the beginning ofevery therapy session.

While the foregoing contemplates use of a sensing mechanism along withthe delivery of stimulation to monitor the functionality of the signalchain (e.g., to determine whether amplifiers are becoming saturated),the techniques described herein may also be used to detect saturation inthe absence of stimulation. For instance, movement of a patient maycause spikes in the detected signals that result in the saturation ofthe sensed signals. Use of the disclosed techniques can detect thissaturation and provide adjustments to the signal chain (e.g.,adjustments to the amplifier gain) so that sensing can continueuninterrupted even when the patient is moving. This type of sensing andadjustment can occur with, or without stimulation. Thus, while examplesabove describe sensing during stimulation, the techniques describedherein are not so limited, and can be used in the absence of thedelivery of stimulation to improve signal sensing capability.

It will be appreciated that various operating steps of the system can becarried out manually or automatically. For example, a clinician,patient, or other system operator can interface with the system viaprogrammer 14 or other external device as described in U.S. Pat. No.8,428,733, which is incorporated by reference. In such examples, thesystem operator can observe evidence of saturation in processed sensesignals and initiate appropriate action to eliminate the saturation. Inother examples, the processor 40 can access information stored in anyone or combination of operating instructions 58 and therapy programs 54in memory 42 of the system to automatically detect the occurrence ofsaturation and to take appropriate action.

Various examples of the disclosure have been described. While manydescribed embodiments included system for stimulating and sensing from apatient's brain tissue, these are not intended to limit the scope of theinvention. For instance, the foregoing techniques can be used in systemfor only sensing, such as purely diagnostic system. Additionally oralternatively, systems can be used in other physiological sensingapplications, such as neural tissue outside of the brain, muscle tissue,etc. These and other examples are within the scope of the followingclaims.

The invention claimed is:
 1. A method comprising: applying a stimulation signal to a patient, the stimulation signal comprising a stimulation frequency within a first frequency band; while applying the stimulation signal, simultaneously receiving a signal from the patient, wherein the received signal comprises a sense signal comprising frequency content within a second frequency band, the second frequency band being distinct from the first frequency band; applying a test tone signal simultaneously with the stimulation signal, the test tone signal comprising a test frequency outside of the first and second frequency bands; in real time, using a processor, processing the received signal to produce a processed signal, wherein the processed signal comprises at least a first signal component from the sense signal and a second signal component caused by applying the test tone signal; using the processor, monitoring at least one reliability signal indicative of the reliability of the processed signal, wherein monitoring the at least one reliability signal comprises monitoring a magnitude of the second signal component, caused by applying the test tone signal, at the test frequency in the processed signal; and in response to the reliability signal meeting at least one predetermined criterion, using the processor, automatically performing at least one action to improve the reliability of the processed signal, wherein the reliability signal meeting the at least one predetermined criterion comprises the magnitude of the second signal component, caused by applying the test tone signal, at the test frequency being less than a predetermined threshold, and wherein performing at least one action to improve the reliability of the processed signal comprises adjusting at least one of (i) the stimulation signal, (ii) the processing of the sense signal, and (iii) the test tone.
 2. The method of claim 1, wherein: processing the received signal comprises amplifying the received signal via an amplifier; and performing at least one action to improve the reliability of the processed signal comprises reducing the gain of the amplifier.
 3. The method of claim 1, wherein the first frequency band comprises frequencies between 120 Hz and 160 Hz, and the second frequency band comprises frequencies between 0 and 100 Hz.
 4. The method of claim 3, wherein the test tone frequency is approximately 105 Hz.
 5. The method of claim 3, further comprising generating a graphical display for user analysis, the graphical display including representation of the frequency content of the sense signal over time.
 6. The method of claim 1, wherein: applying the stimulation signal to the patient comprises applying the stimulation signal to a patient's brain; receiving the signal from the patient comprises receiving the signal from the patient's brain; and applying the test tone signal comprises applying the test tone signal to the patient's brain.
 7. The method of claim 6, wherein applying the stimulation signal to the patient comprises applying a signal of sufficient magnitude in order to effect a desired change in the sense signal.
 8. The method of claim 7, wherein the desired change in the sense signal comprises reducing the magnitude of beta waves in the sense signal.
 9. The method of claim 7, wherein the desired change in the sense signal comprises increasing the magnitude of delta waves in the sense signal.
 10. A system for providing and confirming treatment to a patient comprising: a stimulation processor coupled to at least one stimulating electrode and configured to provide a stimulation signal to a patient for providing treatment to the patient, the stimulation signal comprising a stimulation frequency within a first frequency band; a test electrode, the test electrode configured to apply a test tone signal simultaneously with the stimulation signal to the patient, the test tone signal having frequency content comprising a test frequency separate from the first frequency band; at least one sensing electrode configured to receive signals from within the patient; a signal chain in communication with and configured to receive a signal from the at least one sensing electrode, process the received signal, and in real time, output a processed signal, wherein the processed signal comprises at least a first signal component from a sense signal and a second signal component caused by applying the test tone signal, and wherein the sense signal comprises frequency content within a second frequency band, the second frequency band being distinct from the first frequency band and the test frequency; and a processor in communication with the signal chain and configured to: (i) receive the processed signal from the signal chain, the processed signal including real-time data indicative of the effectiveness of the simultaneous stimulation signal during the application of the stimulation signal by the stimulation processor; (ii) analyze a reliability signal based on one or both of signal chain operation and the content of the processed signal, the reliability signal being indicative of the reliability of the processed signal, wherein analyzing the reliability signal comprises comparing the magnitude of the second signal component, caused by applying the test tone signal, at the test frequency in the processed signal to a predetermined threshold; and (iii) in the event that the reliability signal meets at least one predetermined criterion, automatically performing at least one action to improve the reliability of the processed signal, wherein the at least one action comprises adjusting at least one of (i) the stimulation signal, (ii) the processing of the sense signal, and (iii) the test tone.
 11. The system of claim 10, wherein the real-time data indicative of the effectiveness of the stimulation signal comprises the magnitudes of one or more components of the processed signal at least one frequency band, and wherein a change in magnitude of the one or more components of the processed signal at least one target frequency band is indicative of the effectiveness of the simultaneous stimulation signal, wherein the at least one target frequency band comprises a frequency separate from the first frequency band and separate from the test frequency.
 12. The system of claim 11, wherein the at least one action performed to improve the reliability of the processed signal comprises adjusting at least one component of the signal chain.
 13. The system of claim 12, wherein the signal chain comprises at least one amplifier, and wherein adjusting at least one component of the signal chain comprises adjusting the gain of at least one of the at least one amplifier of the signal chain.
 14. The system of claim 10, further comprising a display configured to present a graphical representation of the frequency content of the sense signal over time.
 15. The system of claim 10, wherein the entire system is implantable into the body of the patient.
 16. An automated system for simultaneously stimulating tissue of a patient and sensing physiological effects of the stimulation on the patient comprising: a processor configured to provide (i) a stimulation signal patient via at least one stimulation electrode and (ii) a test tone signal to the patient via at least one test electrode, the stimulation signal comprising a stimulation frequency included in a first frequency band and the test tone signal comprising a test tone frequency outside of the first frequency band; at least one sense electrode configured to receive a sense signal from the patient; at least one amplifier configured to amplify the sense signal received from the at least one sense electrode, the at least one amplifier having an adjustable gain; a processor in communication with the at least one amplifier and configured to: (i) receive the amplified sense signal from the at least one amplifier; (ii) determine the magnitude of a component in the amplified sense signal at the test tone frequency component; (iii) compare the magnitude of the component in the amplified sense signal at the test tone frequency in the amplified sense signal to a predetermined threshold; and (iv) if the magnitude of the component in the amplified sense signal at the test tone frequency in the amplified sense signal falls below a predetermined threshold, automatically lower the gain on the at least one amplifier.
 17. The automated system of claim 16, wherein the processor in step (iv) incrementally lowers the gain until the magnitude of the component in the amplified sense signal at the test tone frequency until the amplified sense signal returns above the predetermined threshold.
 18. The automated system of claim 17, wherein the processor saves the gain at which the amplified sense signal returns above the predetermined threshold in memory.
 19. The automated system of claim 16, further configured to monitor a change in the sense signal in at least a second frequency band separate from the first frequency band and the test frequency.
 20. The automated system of claim 19, wherein the first frequency band comprises frequencies between 120 Hz and 160 Hz, the second frequency band comprises frequencies between 0 and 100 Hz, and the test tone frequency is approximately 105 Hz. 